HomeMy WebLinkAbout01-27-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF ~,' alrth e s+ ~4 h ~~ Cp>;))~y~ PENNSYLVANIA
Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters. as specified below, and in
support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form:
Decedent's Information
Name:~j eo~g e_ h?, L~a~/.l~io~Grer ~~ "'~ ~ DI J
a/Wa. File No:
a/Wa: (Assigned by Register)
a/Wa:
Date of Death• Social Security No: ~ 8'y ~ 78• ~ O l,2 Q
• 1 ~ -31 ~ O!! Age at death: ~' 7
Decedent was domiciled at death in Cus„b~h ~it ~Q
principal residence at %QrC ~'~ t ~ ~ County, ~e„~,~„ /ah ,4 (ware) with his/her last
a/y~~ ~~t`t`o~t I7~GG Sa 'f~ 11o wfiN
Street address, Post Office and Zip Code ~~ ~~i"l4HG-
Clty, Township or Borough County
Decedent died at f~ Qs ¢ }~,' s p`,, ~ ~ f Q ~~u f. ao jets y,~ ~ 7~~( s*ou ~,r,~ ~/etyl"
Street address, Post Office and Zip Code City, Township or Borough Coun oyTw~ ~~~~~
Estimate of value of decedent's property at death: ty State
Q.
If domiciled in Pennsylvania .................. ...... All persona! property $ L/ J/~Qt o~'
If not dotnieiled in Pennsylvania .................. .
If not domiciled in Pennsylvania ....................... Personal propel to Pennsylvania $
Value of real estate in Pennsylvania ...................... . p p T~' to County $
........
TOTAL ESTIMATED VALUE.... $ e~-"~'-
Real estate in Pennsylvania situated at:
(Attach additional sheets, ijnecessary.) Street address, Post Office and Zip Code
City, Township or Borongh County
[j A. Petition for Probate and Grant of Letters Testaments
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated tJ~Gth p ~ Ot9
thereto dated ~ ~ and Codicil(s)
State relevant circumstances (eg. renunciation, death ojexecutor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not ma 4
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. S~ Wa3323dtvorc notapar~toape
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. (g)~ an~ VO a~ld bo .
^ NO EXCEPTIONS ^ EXCEPTIONS
tN rY-~
~..1 =y.7
^ B. Petition for Grant of Letters of Administration (If applicable) ~ ~ c~`~
c.t.a., d.b.n., d.b.n.c.t.a., pendente life, durantea ~tia, duraN~prnino ,_
s'•
If Administration, c.t.a. or db.n.caa., enter date of Will in Section A above and com let~st of heir ~,
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined
in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
^NO EXCEPTIONS ^ EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent lefr no Will and was survived by the following spouse (if any) and heirs (attach
udditiorsal sheets, ifnecessury):
Fnrm RW-t71 rev. JO/!1/10/!
Page 1 of 2
of Petition sand ___. r.. ~...,~,~s~ ~~ """mtsl me statements m the foregoing Petition are true and con~ect to the best of the lmowledge and belief
~{) that, as Personal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate accord;ng to law.
Sworn to or firmed d subscribed before ~,,,~ `e., ,,~, n ~ / /
met 's ~ day. o ,off ~. ~^S.Lt/1./~~.~,..., Dat `- ~ 7- /
$Y' ,( ~ Date
For the Register Dam '
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>30ND Required: 0 YES NO ~
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FEES: To the Register ojWi/!s: ~~, ~ ~ N
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Please enter m a
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Letters .. B~
' ~ ' ' ' ' ' ' ' ' ' ' $
(~ )Short Certificate(s).....
Attorney Signature: ;
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( )Renunciation(s)......... ~~ ~
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( )Codicil(s) ............ ~ `'~ !
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( )Affidavit(s)........... W
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Bond ..... .:.........
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Commission .. ........
Printed Name:
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Automation Fee...... Phone: ~ - ~ ~v
JCS Fee.... Fax: _ _
TOTAL... . ' • . ' , ... ~ ~ ~ ' ~ ~ ~ ~ Email:
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DECREE OF THE REGISTER
Estate of (~ ~~~_f~
a1k/a: File No: ~ - (~ ~ ~ 7
AND NOW, 'N` ~,- ~
satisfactory proof having been presented before me, I S DECREE~tt ~ onsideration of the fore ing Petition,
are hereby granted to
the instrument(s) dated in the above estate and .(if applicable) that
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) bf Decedent.
r
Register of Wills ~~.}-
Form RW-02 rev. /0//!/2011 ~`" • ~~~~
Page 2 of 2
LOCC~~~'R'S CERTIFICATIO
WAR~`#~~~ duP~lcate this co b hotostaN OF tDEATH
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Fee for this certificate, $6.00 ~#~~ .1AN ~1 AM 9~ 53
S C~(}tIRT
P 18 218 213 ~~~ ~~~
Certification Number
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This is to certify that the information here given
correctly copied from an original Certificate of Deg
duly filed with me as Local Registrar. The origin
certificate will be forwarded to the State Vii
Records Office f rrrianent filing.
Local Registrar /
Date Issued
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LAST WILL AND TESTAMENT
~~
~7 ~'
OF ~ ~
,..~ x'" '~ ~?
x ~,-~
GEORGE M. BURKHOLDER ~vi~ ~ ~S
~=~} r-
~~ ~ ~ _ `~?
I, GEORGE M. B `~ `'
URKHOLDER, Earl Township, County of Lancaster and common ~ ~ rn
filth' ~'.-
Pennsylvania, being of sound mind, do declare this to be my last Will, hereby revokin ~
g any and all Wills and
Codicils by me at any time heretofore made.
ITEM I.
---' ~` "'_' =W ~•aai~ 1 A~1~1 VE. I name, constitute and appoint
my son, WEAVER G. BURKHOLDER, Executor of this my last Will. In the event my said Execut
or
Predeceases me or dies before my estate is settled, or if for any reason he is unable or umvillin to serv '
capacity, I then g e In that
appoint my daughter, LUCY G. SENSENIG, Executrix in his place and stead. My Executor
or Executrix shall hereinafter be referred. to as my "personal Representative."
ITEM II. P_AY_ 1~__NT OF DERTS AND FTt1yFu
.AL EXPENCFC, I order and direct my Personal
Representative to PaY my just debts and funeral expenses as soon after my decease as ma be co
Y nvement.
ITEM III. DISTRIBUTION. I give, devise and bequeath all of my estate, both real and
personal,
unto my wife, ELIZABETH H. BURKHOLDER. Should my wife predecease me or die within
my death, I direct my Personal Representative to hold a famil au ~~ days of
y coon of my tangible personal property with
the proceeds therefrom to be added to and distributed as part of my residuary estate.
I give, devise and bequeath all the rest, residue and remainder of my estate, both real and
absolutely, unto my children, in equal shares, the issue of any deceased c personal,
luld to take the share of such
deceased child, per stirpes, and in the event any child dies leaving no issue survivin I
g, then give the share
to which such deceased child would have been entitled if living unto my surviving children
ITEM V. PAYMENT O DEATH TAXFS. I direct that all estate, inheritance and
other taxes in the
nature hereof, together with any interest or penalties thereon becoming laayable because of m death
Y , vv~th
respect to the property constituting my gross estate for death tax purposes, whether or not such ro
under this Will, shall be paid from the residue of my estate; and no le atee o P ~~ passes
g r devisee or any person having
a beneficial interest in any such property, whether under this Will or any Codicil thereto or oth
at any time be required to refund an ~~~ shall
y part of such taxes. Taxes on future interests may be prepaid.
ITEM VI. GUA_R~~ OF THE ESTAT
E. I appoint my Personal Representative Guardian of the
Estate for any minor beneficiaries of mine, whether under this Will or some other instrument su
ch Guardian
being empowered to receive assets for such minor of any kind whatsoever. My said Guardian
shall have the
power to use so much of the income and principal of such assets for any such miner as is neces
discretion of my Guardian, for such minor's education, medical care ands ~' in the
upport, taking into consideration all
other sources of income available to such minor.
ITEM VII. WAIVER OF BOND. I direct that none of the fiduciaries a
Ppointed under this instrument
be required to give bond.
IN WITNESS WHE~pF, I have hereunto set m ~'
Y bend and seal this ~ ` ~y of
A.D., 2001.
George urkhol er (SEAL)
THIS INSTRUMENT, consisting of three (3) typewritten pages, was by the above-named Tes
gne ,
the date hereof si d sealed, published and declared to be his last Will acid tator, on
Testament, in the presence of
the undersigned, who, at his request, in his presence and in the presence of each other
have hereunto
subscri d their names as .'tresses.
residing at ~
~.,.eQQ ,
residing at
2
COMMONWEALTH OF PENNSYLVANIA .
COUNTY OF LANCASTER SS:
We, George M. Burkholder,
and _ ~) ~[1 rs ~ur ~i hok~er
the Testator and the witnesses, respectively, whose names
aze signed to the attached or foregoing instrument, being first duly affirmed, do hereb de
undersigned authority, a Notary public, that the Testator si ed an Y Glaze to the
~ d executed the instrument as his last will
and that he had signed willingly, and that he executed it as his free and voluntary act for the
expressed, and that each of the witnesses, in the presence and hearin o p~poses therein
g f the Testator, signed the Will as
witness and that to the best of his or her knowledge the Testator was at that time ei teen 1
~ ~ g) years of age
or older, of sound mind and under no constraint or undue influence.
eorge urkholder Testator
Witness
` Witness
Subscribed, af~'irmed to and acknowledged before me, a Notary Public, by George M. Bur
kholder, the
Testator, and subscribed and affirmed to before me by S' h'i ,
~ e .Tr,
and ~) a ~ . ~f~i h~lc~w- ,witnesses, this y ~ da
y of 7~Gn~
A.D 2001.
,~ya„~ s seal
~, Lam, ~ No4ry PiibYc
Member ~en~ free ~r'e~2, Zp(q
nia gssc±c-e~ ~
Notary Pub is
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